ÐÏà¡±á>þÿ <>þÿÿÿ9:;ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿì¥Ái ð¿!ábjbjÚàÚà ©æ¸ŠHf¸ŠHfâ@÷ÿÿÿÿÿÿ·ˆ ˆ ÍÍÍÍÍ4ÿÿÿÿhiœ¼y&ÁÁ"ãããAxCxCxCxCxCxCx$<{¶ò}gxiÍgxÍÍãã4Ðxûûû‚ÍãÍãAxûAxûûº o¬wãÿÿÿÿphVNŸ*Õÿÿÿÿ™v¹qJ-xæx0yr‚~|‚~”w‚~Íwûgxgx‹pyÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿ‚~ˆ “: American Psychological Association Designation Program for Postdoctoral Education and Training Programs in Preparation for Prescriptive Authority Approved by APA Council of Representatives, 2019 Application Form Program Name: If housed within a larger institution, identify the institution: Program Address: Program Director: Contact Information: Telephone: Fax: Email: Instructions: For each of the following standards, review the document titled Designation Criteria for Education and Training Programs Leading to Prescriptive Authority for the information required. Note that this application summarizes documentation requirements; the Designation Criteria document provides more complete descriptions for many of the standards. Provide your responses in the space provided. Any supplementary materials (applications, brochures, copies of web pages, etc.) should be attached at the end of the application as a series of appendices ordered by letter. Each appendix should be preceded by a single page containing the title for the appendix, e.g., Appendix C Course Catalog Only include one copy of any document, even if that document will be used to address several standards. In your responses to standards, make sure you indicate the location of supporting information in the attached documents, e.g., “The admissions requirements may be found on p. 7 of the Program Manual found in Appendix D. This manual is provided to all potential applicants.” In identifying the location of relevant information in the documents, be as specific as possible. If the appendix contains a multi-page document, indicating the page number and/or heading for the relevant material will be helpful. Criterion P: Program (P) Characteristics P1. Academic Institution Provide evidence that the program is offered at a regionally accredited institution. P2. Admissions Submit a copy of any documents or other materials (e.g., program website content, program brochures, catalogs) that demonstrate how you inform potential applicants of the requirements for participation in and completion of the program. Submit a copy of the student application form and any other forms that you use to gather information about current licensure, completion of a doctoral program in psychology, and practice as a health service provider. If your program allows students to complete a portion of their training at the doctoral level provide information as to how you ensure they are enrolled in a doctoral program that is accredited by the APA or an accrediting body recognized by the U.S. Secretary of Education for the accreditation of health service psychology in preparation for entry to practice. Do you accept applicants not meeting the stated requirements? j Yes j No If yes, please explain Over the last three years, what percent of your admissions were exceptions? P3. Transfer of Credit 1. Does your program accept transfer credit? j Yes j No If yes, describe your policies for accepting transfer credit. This should include courses in your curriculum for which you accept transfer credit and the maximum percent of your curriculum for which you allow transfer credit. If you allow advanced placement based on prior education and training, provide us with your program policy for establishing competency and currency of knowledge base. P4. Ethical Standards Describe how the current Ethical Principles of Psychologists and Code of Conduct of the American Psychological Association is made available to faculty members and administrators who are psychologists. Provide a copy of program policies indicating that students will be treated in a fair and ethical manner consistent with the current Ethical Principles of Psychologists and Code of Conduct of the American Psychological Association. P5. Public Representation of the Program 1. Attach a copy of your current mission statement. 2. Indicate how this mission statement is communicated to the public. 3. Provide copies of materials for public dissemination indicating the program is an education and training program for psychologists in psychopharmacology for prescriptive authority. P6. Program Resources 1. For those components of the program that are conducted in a classroom setting, describe the physical resources available to the program. For those components of the program that are provided via computer or other electronic media, describe the systems used to support those program components. 2. Describe all additional resources available to students. These can include laboratory space, clinical settings, library materials (electronic and/or physical), pedagogical resources, access to relevant websites, or any other resources that may enhance the student’s learning experience. 3. Provide evidence to suggest that sufficient financial resources exist to ensure the program will be sustainable at least for the duration of the current student body. This can, for example, include the description of the current financial status of the sponsoring organization, if such an organization exists, or demonstration that the materials and resources needed for completion of the current cohort are already in place. This description should address maintenance of those resources described in response to #1. P7. Governance Describe the governance structure for the program and qualifications of the administrators. Please attach an organizational chart for the program and curriculum vitae for the program director and other program administrators. 2. Provide materials or otherwise describe the mechanism(s) by which faculty is informed of their rights and program policies. 3. Describe grievance and due process procedures available for faculty in the program. P8. Faculty For each course or course module or supervised clinical experience, as appropriate to your curriculum, provide the name and current curriculum vitae of the primary instructor currently teaching that content area. Provide evidence of licensure in good standing (if applicable) for each faculty member and clinical supervisor. P9. Quality Assurance 1. Describe current consortial arrangements or contractual agreements used in the didactic or supervised clinical experience of students. This includes supervisors involved in the experiential components of the training. 2. Describe mechanisms used to ensure the quality of education training offered through those agreements, including methods for the evaluation of supervisor competence in the experiential components of the training. 3. Provide evidence of licensure in good standing (if applicable) for each faculty member and clinical supervisor. P10. Program Self-Evaluation 1. Describe procedures for program self-evaluation, including how often formal self-evaluation takes place and how this information is used. 2. Describe how the program maintains currency of course materials given the rapid evolution of knowledge. P11. Diversity Describe how the program engages in systematic, coherent, and long-term efforts to attract and retain students and faculty from diverse backgrounds into the program. Criterion S: Students (S) S1. Student Body How do you define an active student in your program? Please fill in the following information: Program Training Model DoctoralPostdoctoralDidacticDidacticPrescribing Psychology FellowshipNumber of Students Currently EnrolledNumber of Students who Completed in the past 3 years Please describe the diversity of your student body. If any trainee has taken in excess of five years to complete the postdoctoral training program, please provide an explanation. S2. Maintenance of Licensure 1. Provide materials or otherwise indicate how students are informed they are expected to (a) maintain a status of “in good standing” for doctoral students and licensure for postdoctoral students throughout the course of the program; and (b) inform the program director at any time of changes to their standing or licensure. S3. Student Records Describe methods used to ensure the security and maintenance of student records stored in either paper or electronic form. Describe the mechanisms used to assure the long-term maintenance of student records. Provide the sample of a transcript or official documentation that confirms successful completion of program requirements. Provide a sample of the certificate of completion of all program components (didactic, supervised clinical experience, and capstone competency evaluation). S4. Due Process 1. Provide materials or otherwise describe the mechanism(s) by which students are informed of their rights and program policies. 2. Describe grievance and due process procedures available for students in the program. Criterion C: Curriculum (C) C1. Didactic Curriculum Provide a current syllabus for each course or course module. This syllabus should, at a minimum, include a description of expected student learning outcomes for each course or course module and how student performance is assessed. Provide the curriculum vitae of each instructor for each course or course module. Create a grid that indicates the number of hours in each course dedicated to each of the content domains required for the program. A template for the grid is attached. Different programs share content but organize the curriculum in different ways and use different course titles. For each course in your program, indicate the number of contact hours associated with each content domain reflected in the model curriculum. Content Mapping ChartCourse or Course Module: Identify courses below the grid (e.g., “1 = Clinical Medicine”) Add more columns if you have more than 10 courses or modules.12345678910I. Basic Science Human anatomy Human physiologyBiochemistryGeneticsII. Functional neurosciencesa. Neuroanatomy b. Neurophysiology c. Neurochemistry III. Physical examination Measurement and interpretation of vital signsb. Neurological examc. Cardiovascular examRespiratory examAbdominal examinationEye, ear, nose, and throat (EENT)Gastrointestinal (GI)Genitourinary (GU)IntegumentaryAllergic/immunologicMusculoskeletalIV. Interpretation of laboratory tests a. Therapeutic drug monitoringb. Other blood and urine testsc. Radiologyd. Electrocardiogram (EKG) and brain electrophysiology Neuroimaging techniques (e.g, magnetic resonance imaging [MRI], functional MRI [fMRI], computerized tomography [CT])f. Applied geneticsV. Pathological basis of diseasePathophysiology of common cardiovascular, respiratory, gastrointestinal, hepatic, neurological, and endocrine conditions VI. Clinical medicinea. Clinical manifestations, differential diagnosis, and laboratory or radiological evaluation of commonly encountered medical conditions Special cases: children, women, and older adults, health related conditions (e.g., pregnancy, hormone therapy), and people living with chronic health conditions (e.g., hypertension, diabetes, HIV/AIDS, Hep C, breast and hematological cancers and conditions) c. Medical emergencies and their management VII. Clinical neurotherapeuticsElectrophysiology (e.g., quantitative electroencephalogram [EEG], Neurofeedback) Non-invasive interventions (e.g., transcranial magnetic stimulation, EEG, neurofeedback, biofeedback)c. Electroconvulsive therapy (ECT)VIII. Systems of carea. Coordination of care with other medical specialtiesb. Consultation and referralsCoordination and consultation in long-term careIX. PharmacologyPharmacokinetics and drug delivery systemsPharmacodynamicsNeuropharmacologyToxicologyMechanisms of medication interactionsX. Clinical pharmacologyMajor drug classesNutritional supplementsSpecial cases: children, women, and older adults, health related conditions (e.g., pregnancy, hormone therapy), and people living with chronic health conditions (e.g., hypertension, diabetes, HIV/AIDS, Hep C, breast and hematological cancers and conditions)XI. PsychopharmacologySedatives/hypnoticsAntidepressantsAntipsychoticsMood stabilizersAnxiolyticsStimulantsMedications for drug dependenceMedications for drug adverse eventsPediatric psychopharmacologyGeriatric psychopharmacology (including medications for cognitive impairment)Issues of delivery and cultural competence in pharmacological practice (e.g., sex assigned at birth, gender identity, race, ethnicity, culture, socioeconomic status, disability, nationality or origin, generational status, citizen status, other forms of population diversity, traditional practices, and lifespan factors related to drug metabolism access, acceptance, and adherence)XII. Psychopharmacology researchPhases of drug developmentClinical trials in psychiatryCritical evaluation of evidenceXIII. Professional, ethical, and legal issuesDocumentation (e.g., nomenclature, abbreviations, prescription Writing)Conflicts of interest/relationships with the industryScope of practice issuesDiversity and equity issues related to treatment access and adherenceC2. Supervised Clinical Experience Supervised clinical experience in physical assessment The program will demonstrate the manner in which it verifies that the specific competencies have been achieved. Should the program choose to integrate the physical assessment practical training with didactic coursework, the program shall demonstrate the manner in which it is integrated. Prescribing psychology fellowship Describe how your program implements the prescribing psychology fellowship component of training. Describe in detail: how supervisors and settings are identified, approved, and overseen by the program; mechanisms for ensuring that the range of supervised clinical experiences balances diversity, developmental considerations, and appropriateness to the student’s practice; the skill sets considered critical for each of the eight competency domains and how the developmental and diversity issues are addressed; how progress toward attainment and mastery of competence is evaluated for each of the eight competency domains listed. Provide copies of all materials used by the program to evaluate student performance in the completion of the prescribing psychology fellowship. Provides copies of forms used by the student and the supervisor to document students’ face-to-face patient contact hours. C3. Capstone Competency Evaluation 1. Describe in detail your program’s capstone evaluation process, including how outcome is determined. 2. In each of the last three years, how many students have participated in the capstone competency evaluation? How many in each year have passed? C4. Certification of Completion 1. Some programs elect to provide some form of recognition upon completion of didactic coursework even if the supervised clinical experience is not yet completed. Does your program offer this option? j Yes j No If yes, indicate what form this recognition takes (certificate, master s degree, etc.) What form of recognition do you give for completion of all program components? Please submit a sample copy. 3. 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Æhgd`i Æh„h„˜þ^„h`„˜þgdý$ Æh7$8$H$gdýC'D(D D¡D1E2E®EÒEÓE:F;FÍFîFïF¸G H"HÐH÷ò÷áÙÔÙÔÔááááÅá®á¢ &F Æhgdý$ Æh„h„˜þ7$8$H$^„h`„˜þgdý$ Æh7$8$H$gdýgdý &F gdý Æh„h„˜þ^„h`„˜þgdýgd -ë &F"gd -ëFÍFÎFíFîFïFG¸G H"HÐHÒHªI¬I®IJÜÜÜÜ#ÜeÜ›Ü¹ÜÕÜâÜäÜåÜÝ Þ"Þ$ÞPÞRÞäÞà&à'à(à)à*à+à,à-à.à/à0à1à2à3à4à5à6à7à8à>à?à@àAàBàCàIàJàüü÷ï÷üüüüüüüüüüíüæÞÙÞæüææüüüüü÷ÑüüÍÍüÅü½¹¹½¹¹½¹¹½¹¹µµ«¥«¥µµ«¥« h»"0Jjh»"0JUh»"h] Ljh] LUh^<hý5h…kñh#|†hý5 h…kñ6h^bhý6h^bhýUh^bhý5 hý5hý>ÐHÒH¬I®IäÜåÜÝ ÞPÞRÞ'à(à)à+à,à.à/à1à2àîæÝîØÏ¸ØØ°¡ŸŸŸŸŸŸŸ$ Æh7$8$H$gdý &Fgdý$ Æh„h„˜þ7$8$H$^„h`„˜þgdý„h^„hgdýgdý Æhgdý &Fgdý Æh„h„˜þ^„h`„˜þgdýs as having completed the APA Model Training Program in Psychopharmacology for Prescriptive Authority until such time as they have completed the didactic, supervised clinical experience, and capstone components of the program. We are compliant with this: j Yes j No C5. Lifelong Learning Please describe how your program prepares students for lifelong learning. This could include exposure to software systems, electronic journals, or medical alerts (e.g. Epocrates, Carlat, Psychiatry Report, Cochrane Reviews, guidelines.gov, UpToDate). 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„€„˜þÆ€^„€`„˜þ‡hˆH.’h „P„LÿÆP^„P`„Lÿ‡hˆH.„Ð„˜þÆÐ^„Ð`„˜þo(.€ „ „˜þÆ ^„ `„˜þ‡hˆH.‚ „p„LÿÆp^„p`„Lÿ‡hˆH.€ „@„˜þÆ@^„@`„˜þ‡hˆH.€ „„˜þÆ^„`„˜þ‡hˆH.‚ „à„LÿÆà^„à`„Lÿ‡hˆH.€ „°„˜þÆ°^„°`„˜þ‡hˆH.€ „€„˜þÆ€^„€`„˜þ‡hˆH.‚ „P„LÿÆP^„P`„Lÿ‡hˆH.„Ð„˜þÆÐ^„Ð`„˜þOJQJo(‡hˆH·ð „„˜þÆ^„`„˜þo(‡hˆH.„Ø „˜þÆØ ^„Ø `„˜þOJQJo(‡hˆH§ð„¨„˜þÆ¨^„¨`„˜þOJQJo(‡hˆH·ð„x„˜þÆx^„x`„˜þOJQJ^Jo(‡hˆHo„H„˜þÆH^„H`„˜þOJQJo(‡hˆH§ð„„˜þÆ^„`„˜þOJQJo(‡hˆH·ð„è„˜þÆè^„è`„˜þOJQJ^Jo(‡hˆHo„¸„˜þÆ¸^„¸`„˜þOJQJo(‡hˆH§ðh „h„˜þ^„h`„˜þ5‡hˆH.h „8„˜þ^„8`„˜þ‡hˆH.’h „„Lÿ^„`„Lÿ‡hˆH.h „Ø „˜þ^„Ø `„˜þ‡hˆH.h „¨„˜þ^„¨`„˜þ‡hˆH.’h „x„Lÿ^„x`„Lÿ‡hˆH.h „H„˜þ^„H`„˜þ‡hˆH.h „„˜þ^„`„˜þ‡hˆH.’h „è„Lÿ^„è`„Lÿ‡hˆH.„h„˜þ^„h`„˜þo(.€ „8„˜þ^„8`„˜þ‡hˆH.‚ „„Lÿ^„`„Lÿ‡hˆH.€ „Ø „˜þ^„Ø `„˜þ‡hˆH.€ „¨„˜þ^„¨`„˜þ‡hˆH.‚ „x„Lÿ^„x`„Lÿ‡hˆH.€ „H„˜þ^„H`„˜þ‡hˆH.€ „„˜þ^„`„˜þ‡hˆH.‚ „è„Lÿ^„è`„Lÿ‡hˆH. „¤„\þÆ¤^„¤`„\þo(‡hˆH. „ „˜þÆ ^„ `„˜þ‡hˆH.’ „p„LÿÆp^„p`„Lÿ‡hˆH. „@„˜þÆ@^„@`„˜þ‡hˆH. „„˜þÆ^„`„˜þ‡hˆH.’ „à„LÿÆà^„à`„Lÿ‡hˆH. „°„˜þÆ°^„°`„˜þ‡hˆH. „€„˜þÆ€^„€`„˜þ‡hˆH.’ „P„LÿÆP^„P`„Lÿ‡hˆH.„Ð„˜þ^„Ð`„˜þo(.€ „ „˜þ^„ `„˜þ‡hˆH.‚ „p„Lÿ^„p`„Lÿ‡hˆH.€ „@„˜þ^„@`„˜þ‡hˆH.€ „„˜þ^„`„˜þ‡hˆH.‚ „à„Lÿ^„à`„Lÿ‡hˆH.€ „°„˜þ^„°`„˜þ‡hˆH.€ „€„˜þ^„€`„˜þ‡hˆH.‚ „P„Lÿ^„P`„Lÿ‡hˆH.h „h„˜þÆh^„h`„˜þo(‡hˆH.€ „8„˜þÆ8^„8`„˜þ‡hˆH.‚ „„LÿÆ^„`„Lÿ‡hˆH.€ „Ø „˜þÆØ ^„Ø `„˜þ‡hˆH.€ „¨„˜þÆ¨^„¨`„˜þ‡hˆH.‚ „x„LÿÆx^„x`„Lÿ‡hˆH.€ „H„˜þÆH^„H`„˜þ‡hˆH.€ „„˜þÆ^„`„˜þ‡hˆH.‚ „è„LÿÆè^„è`„Lÿ‡hˆH.„s„˜þ^„s`„˜þo(.€ „C„˜þ^„C`„˜þ‡hˆH.‚ „„Lÿ^„`„Lÿ‡hˆH.€ „ã „˜þ^„ã `„˜þ‡hˆH.€ „³ „˜þ^„³ `„˜þ‡hˆH.‚ „ƒ„Lÿ^„ƒ`„Lÿ‡hˆH.€ „S„˜þ^„S`„˜þ‡hˆH.€ „#„˜þ^„#`„˜þ‡hˆH.‚ „ó„Lÿ^„ó`„Lÿ‡hˆH.„Ð„˜þ^„Ð`„˜þo(.€ „ „˜þ^„ `„˜þ‡hˆH.‚ „p„Lÿ^„p`„Lÿ‡hˆH.€ „@„˜þ^„@`„˜þ‡hˆH.€ „„˜þ^„`„˜þ‡hˆH.‚ „à„Lÿ^„à`„Lÿ‡hˆH.€ „°„˜þ^„°`„˜þ‡hˆH.€ „€„˜þ^„€`„˜þ‡hˆH.‚ „P„Lÿ^„P`„Lÿ‡hˆH.„s„˜þ^„s`„˜þo(.€ „C„˜þ^„C`„˜þ‡hˆH.‚ „„Lÿ^„`„Lÿ‡hˆH.€ „ã „˜þ^„ã `„˜þ‡hˆH.€ „³ „˜þ^„³ `„˜þ‡hˆH.‚ „ƒ„Lÿ^„ƒ`„Lÿ‡hˆH.€ „S„˜þ^„S`„˜þ‡hˆH.€ „#„˜þ^„#`„˜þ‡hˆH.‚ „ó„Lÿ^„ó`„Lÿ‡hˆH. „Ð„˜þÆÐ^„Ð`„˜þo(‡hˆH. „„˜þÆ^„`„˜þo(‡hˆH.„Ø „˜þÆØ ^„Ø 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